The 2025 budget reconciliation law (H.R. 1) narrowed health coverage for lawfully present immigrants in three steps, one program at a time. If you are a refugee, an asylee, a parolee, a TPS holder, or another lawfully present immigrant who isn’t a green card holder, each of your coverage sources — Medicaid, a subsidized marketplace plan, or Medicare — changes on a different date. The common thread is that federal help is now limited to three groups: lawful permanent residents, Cuban and Haitian entrants, and COFA migrants from Micronesia, the Marshall Islands and Palau.
The Timeline
| Date | Program | What changes |
|---|---|---|
| January 1, 2026 | Marketplace | Lawfully present immigrants with income below 100% of the poverty line who can’t get Medicaid because of their status lose the premium tax credit |
| October 1, 2026 | Medicaid & CHIP | Federal funding for full Medicaid and CHIP limited to green card holders, Cuban/Haitian entrants and COFA migrants; states had to recheck status by this date |
| January 1, 2027 | Marketplace | Premium tax credits and cost-sharing reductions end for refugees, asylees, TPS holders, parolees, visa holders and others outside the three groups |
| Early 2027 | Medicare | Social Security begins ending Medicare for current beneficiaries outside the three groups, after preliminary notices in late 2026 |
Sources: H.R. 1 §§ 71109, 71201, 71301, 71302; CMS guidance to states summarized by State Health and Value Strategies; Center for Medicare Advocacy fact sheet (August 2026).
Medicaid and CHIP: Already in Effect
Since October 1, 2026, states only receive federal funding for full-scope Medicaid and CHIP for non-citizens in the three groups. CMS told states to redetermine affected enrollees before that date regardless of when their renewal was due, first by checking status electronically and then by asking the person for documents. If you received a notice and haven’t answered it, answer it: some people are still eligible through a pathway they may not know about.
What still exists:
- Children and pregnant people. States that elected the “CHIPRA 214” option can keep covering lawfully residing children and pregnant people, including refugees and asylees, with federal funding. Ask your state Medicaid agency whether it has.
- Emergency Medicaid still pays for emergency care — including labor and delivery — for people who meet every Medicaid rule except immigration status.
- Continuous eligibility. CMS guidance says Medicaid continuous-eligibility periods continue even after someone loses qualifying status, though CHIP coverage must end.
- State-funded programs. Some states cover certain immigrants with state-only money. These programs differ widely and some have been capped or frozen; your state agency is the only reliable source.
The Marketplace: One Year of Subsidy Left, Then Full Price
If you lost Medicaid this fall, that loss opens a special enrollment period for a marketplace plan — generally 60 days from the date coverage ended. For the rest of 2026, refugees, asylees and TPS holders with income at or above the poverty line can still receive the premium tax credit. Below the poverty line, they can’t, because of the January 2026 change.
From January 1, 2027, the subsidy ends for everyone outside the three groups. You can still buy a marketplace plan, but at full price. During open enrollment (November 1, 2026 to January 15, 2027 on HealthCare.gov), update your application so the 2027 price you see is real, and compare bronze plans, which can be paired with a health savings account, against silver plans that no longer come with cost-sharing reductions for you. Our 2027 subsidy guide has a worked cost example and the rules for mixed-status families, where eligible family members keep their subsidy.
Medicare: Terminations Start in Early 2027
The law also ends Medicare entitlement for lawfully present people outside the three groups — including people who paid Medicare taxes for years. According to the Center for Medicare Advocacy’s August 2026 fact sheet:
- Social Security planned to send preliminary notices between August and November 2026, asking people to provide evidence of qualifying status, followed by termination notices in late December 2026.
- For current beneficiaries, termination takes effect at the start of 2027 (the fact sheet cites February 1, 2027 for the main group, and refers to January in places).
- Medicare Advantage and Part D enrollment ends automatically when Part A or B ends; plans aren’t required to send their own notice, so the Social Security letter may be the only warning.
- The termination notice is an initial determination with appeal rights through Social Security’s reconsideration process. If your status has changed — for example, you now have a green card — respond with evidence before the deadline.
- CMS’s implementing rule was proposed on July 16, 2026 and was not final as of that fact sheet, so details may shift.
Anyone who regains eligibility gets a special enrollment period to return to Medicare. If you are dropped and are under 65 with a working spouse, the spouse’s employer plan may be an option; check its special enrollment rules, since losing Medicare is a loss of coverage.
Care You Can Use Regardless of Coverage
- Community health centers. Federally funded health centers see patients regardless of insurance or ability to pay and charge on a sliding scale based on income.
- Hospital financial assistance. Nonprofit hospitals must have a written financial assistance policy and must tell you about it; ask for the application before or after care. Many forgive bills entirely below a set income.
- Refugee Medical Assistance. State refugee programs have historically covered newly arrived refugees who don’t qualify for Medicaid, for a limited period after arrival. Ask your resettlement agency whether it is available in your state now.
- Prescription discount programs and manufacturer assistance can cut drug costs for people paying cash.
The Green Card Is the Way Back
Every one of these programs restores eligibility once you become a lawful permanent resident. Refugees must apply to adjust status after one year in the U.S., and asylees can apply after one year. Former refugees and asylees are generally exempt from the five-year waiting period that applies to other green card holders for Medicaid. When your green card is approved, report it to your marketplace (to start the subsidy the following month and switch plans if you need to), to your state Medicaid agency, and — if you were on Medicare — to Social Security.
Work visa holders face the same marketplace change but different options, such as employer plans and HRAs; see health insurance for H-1B and E-2 visa holders.
Frequently Asked Questions
Do refugees still qualify for Medicaid after October 1, 2026?
Not for federally funded full-scope Medicaid, in most cases. Since October 1, 2026, federal Medicaid funding for non-citizens is limited to green card holders, Cuban and Haitian entrants and COFA migrants. Refugees may still get emergency Medicaid, coverage for children and pregnant people in states that use the CHIPRA 214 option, or state-funded coverage where a state offers it.
Can asylees get ACA marketplace subsidies in 2027?
No. From January 1, 2027, asylees lose eligibility for premium tax credits and cost-sharing reductions. They can still buy a marketplace plan at full price. Eligibility returns once they become lawful permanent residents.
Will TPS holders lose Medicare?
TPS holders who are not green card holders are among the groups losing Medicare entitlement under H.R. 1. Social Security planned to send preliminary notices in late 2026, with terminations effective in early 2027 and appeal rights through Social Security's reconsideration process.
I lost Medicaid this fall. Can I get a marketplace plan?
Yes. Losing Medicaid opens a special enrollment period, generally 60 days. For the rest of 2026, refugees, asylees and TPS holders with income at or above the poverty line can still receive premium tax credits; from January 1, 2027, the plan is full price.
How do I get coverage back?
Becoming a lawful permanent resident restores eligibility for marketplace subsidies, Medicaid and Medicare. Former refugees and asylees are generally exempt from the five-year Medicaid waiting period. Report the green card approval to each program as soon as it is issued.
This content is for informational purposes only and does not constitute legal, immigration, or insurance advice. Federal and state implementation of H.R. 1 is ongoing and details, including Medicare termination dates, may change. Confirm with your state Medicaid agency, your marketplace, or Social Security, and consult an immigration attorney or legal aid organization about your status.